Healthcare Provider Details

I. General information

NPI: 1740345065
Provider Name (Legal Business Name): AUSTIN BONE & JOINT CLINIC A PROF A ASSOC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 06/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 E 32ND ST STE 101
AUSTIN TX
78705-2700
US

IV. Provider business mailing address

1015 E 32ND ST STE 101
AUSTIN TX
78705-2700
US

V. Phone/Fax

Practice location:
  • Phone: 512-477-6341
  • Fax: 512-477-1148
Mailing address:
  • Phone: 512-477-6341
  • Fax: 512-477-1148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN M PEARCE
Title or Position: ORTHOPEADIC SURGEON
Credential: MD
Phone: 512-477-6341